Patient directed system and method for managing medical information

ABSTRACT

A system and method is provided for the management of a patient&#39;s medical records by a central data repository under the direction of the patient and enabled by an entity managing records on behalf of the patient. Medical records from a plurality of the patient&#39;s healthcare providers, including past and present healthcare providers, are maintained in this central repository in a way that provides a centralized, comprehensive, and accessible medical history of the patient, as well as a comprehensive organizational structure across all records. An embodiment has the patient directed central repository as the hub in a hub-and-spoke arrangement, where each spoke goes to one of the patient&#39;s healthcare providers, both past and present. The patient&#39;s medical records are collected from all the patient&#39;s healthcare providers, then classified, stored, and organized for use by the patient, healthcare providers, and any other authorized individuals. The records in the repository can be sorted and/or selected in several different ways and displayed to the patient or to his designated medical care providers, and to certain patient designated third parties.

[0001] This application claims priority from and incorporates byreference in its entirety U.S. Provisional Application Serial No.60/349,883 titled “A System And Method For Managing MedicalInformation,” filed Jan. 18, 2002.

FIELD OF THE INVENTION

[0002] The invention relates generally to the field of medical recordsmanagement and in particular to the collection, organization,presentation, and distribution of a patient's medical records.

BACKGROUND OF THE INVENTION

[0003] Having a complete set of medical records significantly improvesthe quality of health care for a patient by establishing a patient'smedical baseline and indicating patterns in the patient's medicalhistory. These records provide information impacted by time and by thediversity of medical view points and knowledge gained from clinicaltests. Having a comprehensive set of data that goes back in time andthat is inclusive of observations and findings from multiple providerswho have seen or treated the patient over time makes a difference in thequality of the information used to accurately diagnose and treat medicalproblems. This is especially true for medical problems in the earlystages of development. Patient records, when consolidated and complete,often show identifiable patterns of symptoms, diagnoses, treatments andresponses to those treatments over the life of the patient. When newhealth issues arise, or an old one recurs, the information and patternscontained in the medical records can help guide health professionals inmaking new diagnoses and in their choices for treatments. Each patient'sbaseline medical information is unique. Many people exhibit unusualreadings on some medical tests as part of their normal healthy baselinestate, even though those same readings might be considered unhealthywhen considered in isolation. In the context of the patient's pasthistory, these unusual readings become part of the patient's baseline,and the repetition of those unusual readings over time is not a majorconcern. However, in the absence of the patient's historical baselineinformation, these unusual test results could provoke misunderstandingsor over-reactions from doctor(s) not familiar with the patient'shistory. The risk of medical errors can be significantly reduced byproviding patient-specific information to doctors currently diagnosingor treating the patient about the patient's adverse effects of pasttreatments, allergic reactions to certain drugs, and general dispositionto certain diseases or health conditions. In addition, part of apatient's medical history can include their family medical history.Historical family records of medical conditions can help determine apatient's level or risks for certain medical conditions, such as heartdisease, diabetes, and breast cancer, and can alert health careproviders when increased screening and other tests are advisable.

[0004] In the past, when a patient generally had one or a handful ofdoctors for most of his life, the doctor(s) more often had records andknowledge of the patient's complete medical history. In today's world, anumber of economic forces and trends in health care are contributing tothe increasing fragmentation of patient records across multipleproviders, and to increasing discontinuity in the knowledge of thepatient's medical history by the patient's doctors over time. Examplesof these trends include the increasing frequency with which patientschange medical insurance and jobs, move residences, and are beingreferred to health care specialists. In addition, it is now more commonfor patients to consult with multiple doctors and specialists fortreatment alternatives and second opinions. On the provider side of thehealth care industry, there is a growing trend toward increasedspecialization on the part of doctors. Also, in response to economicpressures and wide-spread disruptions in the health care industry causedby business insolvency, poor operating results, and by increasingfrustrations with unpopular reimbursement policies and cost-cuttingpractices of hospitals, Health Maintenance Organizations (HMOs), andother health care groups, doctors have become more resolved to closepractices or switch their allegiance to business practices andaffiliations. When they do switch, patients often need to find newdoctors or organizations to provide them care. Today's patient typicallysees many more healthcare providers over his lifetime than was the casein previous generations.

[0005] Each healthcare provider is concerned with the maintenance and/orrestoration of the health of the body and/or mind of the patient. Thehealth care provider may be one person (e.g., sole practitioner), agroup of persons (e.g., a family clinic), or an organization (e.g.,hospital or medical university) that for legal and billing reasons, isthe author, owner, and custodian of only that portion of a patient'smedical records corresponding to the diagnosis or treatment that thehealthcare provider provides to the patient. For today's patient, thereis very seldom a single provider who would have all the records of thepatient's other providers, past and present. Moreover, because patient'smedical records are typically paper-based records, the healthcareprovider incurs overhead costs in maintaining and storing them. Thiscreates an economic incentive for each healthcare provider to try tominimize the records it keeps to only those records pertaining to theportion of the patient's care that the healthcare provider itself hasprovided. When the healthcare provider requires access to other portionsof the patient's medical records (i.e., information about the patientauthored by other healthcare providers), requesting-physicians typicallyonly request and retrieve from these other health care providers medicalrecords that are of immediate relevance to them. Hence only a subset,rather than a complete set, of a patient's medical records are kept by ahealth care provider in order to minimize the additional storage andother administrative costs. For the same economic reasons, a healthcareprovider typically discards a patient's medical records, after thepatient becomes inactive under that provider's care for a legallyspecified time, e.g., 5 to 7 years.

[0006] From the record sending side, there are problems in performingthe transfer of medical records between healthcare providers. There isalso an economic disincentive and therefore a reluctance or a slowreaction for the healthcare provider holding the patient's medicalrecords to transfer copies of a patient's records to other providersbecause the costs of retrieval, copying, and mailing are traditionallyborn by the sending-physician as a common courtesy to thereceiving-physician. To help keep these costs down, the tasks ofadministering, copying, and mailing record copies are often performedonly during slow periods or during lulls in other activities of themedical office staff. The relatively low priority assigned to providingcopies of medical records often results in long delays between therequest for and the delivery of patient records, even when disclosure islegally authorized and record copies required to be released.

[0007] Upon receipt, the receiving-providers often need to reorganizethe paper records according to their own system of record-keeping. Whilethe increased use of electronic medical records (EMRs) over paper-basedrecords has reduced the storage cost, paper-based records are stillprevalent. Over 80% of patients' medical record information still existin paper formats. Doctors continue to make handwritten notes of theirdiagnoses and treatments. In addition, today when records are kept inelectronic form in an Electronic Medical Record (EMR) system, recordsare still commonly transmitted between doctors in hard copy,paper-format. This is true even when both doctors have access todifferent EMR systems because such systems are rarely compatible witheach other. When the transfer of patient information is between onecomputer application and another, the computer applications maintainingthe electronic medical records typically differ between health careproviders. So, if it is deemed necessary to convert paper records intoelectronic format for information consolidation and processing, thereceiving-provider would have to bear the cost of converting records toelectronic format, including record storage costs and the ongoing costsof creating scanned images of paper-based records. Rather thanconverting records from sending-providers into electronic format, orfrom sending-providers' electronic format to paper-based and then to thereceiving-providers' electronic format, today's common practice is forrecipient-providers to simply review the paper copies of recordsreceived and file them away with the rest of the patient's paper-basedrecords providers.

[0008] Thus, because each healthcare provider typically keeps their ownmedical records of the patient and because there is little actualsharing or records between healthcare providers, the result is afragmentation of a patient's medical records across the multiplehealthcare providers. In effect each healthcare provider becomes a partof a puzzle of the patient's medical history, and no healthcare providersees the whole picture. This fragmentation of information about thepatient is further exacerbated by the patient's increasing use ofspecialists and increasing need to switch health insurance plans andhealthcare providers in order to pursue better care or to reduce cost ofthe premium. The increase in providers seen in the context of littlereal sharing of patient's medical records across providers also resultsin increasing incidence of redundant tests and of treatments that aredone in lieu of each new doctor have timely access to a patient'scomplete medical records. In addition, as the Institute of Medicinesummarized in a 1999 report, lack of communication and information onpatient medical conditions and history of drug reactions can be cited asa key reason that medical errors result in thousands of other-wisepreventable deaths each year. On the provider side, there are economicpressures for providers to switch health affiliations due to poorbusiness results or business insolvency of their current practice oraffiliations or due to increasing frustration with reimbursementpolicies and cost-cutting practices of hospitals, HMOs and other healthcare groups.

[0009]FIG. 1 illustrates the fragmentation puzzle of a patient's medicalrecords of the prior art. A patient has typically many healthcareproviders over the patient's life, e.g., hospitals A and H, doctors B,C, D, and E, and other provides F and G (e.g., providers of Chiropracticor Homeopathic medicine). Doctors B and C illustrate by overlap area 110the case when two healthcare providers share some, but not all theirmedical records. If two healthcare providers share all their recordsthen for the purposes of this application, they are considered to be thesame healthcare provider. In addition a patient may keep her own files.

[0010]FIG. 2 is a block diagram of an example flow of a patient'smedical records among different healthcare providers of the prior art,that results in the fragmentation puzzle of FIG. 1. FIG. 2 illustratesthat a partial transfer, or in some cases no transfer, of a patient'srecords from one healthcare provider to another causes more and morefragmentation of a patient's medical history over a patient's lifetime.While in this example, for illustration purposes, medical records aredescribed as transferred between health care providers, the records areactually transferred from one health care provider's medical recordrepository or filing system to another health care provider's medicalrecord repository or filing system. In this example, a patient beginswith a general practitioner 110, e.g., a pediatrician, when the patientwas a child. The patient then has general practitioner 112 as an adult.General practitioner 112 thinking that it was too long ago, decides notto request past medical records from general practitioner 110 andinstead relies on a patient interview to fill in the patient's medicalhistory. As a patient's memory is often fuzzy and a poor substitute forclinical information, general practitioner 112 gets an incompletepicture of the patient's childhood medical history. General practitioner112 may send the patient to a specialist 114, e.g., a surgeon for anappendectomy. The specialist 114 gets some of the patient's medicalrecords from general practitioner 112 (path 113 a) and may also requestother historical records from general practitioner 110 (path 118). Thespecialist 114 creates her own records and transfers all or most ofthese initial records, but not all ongoing records, back to generalpractitioner 112 (path 113 b). The patient continues to see thespecialist 114, at times without the General Practitioner 112. Theongoing updates by the specialist 114, after the initial introduction,are usually not managed and so any new information accumulated on thepatient would most likely not be communicated back to GeneralPractitioner 112. General practitioner 112 meanwhile continues to addnew records as he continues to care for the patient. When the patientmoves to a new general practitioner 120, for example, because of moving,changing jobs or switching to a health plan to which generalpractitioner 112 is not affiliated, the new provider will need access tothe patient's medical history. As illustrated, the possible paths forgeneral practitioner 120 to get a complete set of medical records isbecoming complex. To get a complete medical history of the patient,general practitioner 120 needs medical records from general practitioner110 (path 131), general practitioner 112 (path 130) and specialist 114(path 132). However, to reduce costs and because of the delay in gettingthe records, general practitioner 120 may only request some “needed”records from general practitioner 112 (path 130) and no records fromgeneral practitioner 110 (path 131) or specialist 114 (path 132). Ifgeneral practitioner 120 refers the patient to specialist 122, thenspecialist 122 has many paths, i.e., 121 a, 134, and from which he mayneed medical records. However, specialist 122 may, to cut costs, onlyrequest the patient's medical records from general practitioner 120(path 121 a). Note that at this point no single provider necessarily hascomplete records on all patient medical care. Thus as this exampleindicates, as a patient goes from healthcare provider to healthcareprovider, the patient's medical records often get more and morefragmented. Further, at some point, practitioners will discard thepatient's medical records and vital information may be forever lost andwill not be available at a critical time.

[0011] Several prior art systems have tried to solve the fragmentationproblem by providing a centralized computer storage area available tothe patient for storage of some of a patient's medical records. However,these prior art systems only store a small subset of a patient's medicalhistory. Most examples of these prior art systems are Electronic MedicalRecord (EMR) systems that have scope and function limited to the portionof the patient's records corresponding to only that provider's care. Onesystem allows a patient or his doctor to fax in to the centralrepository copies of the patient's medical records under their control.Some minimal organization of the scanned images is done manually by thepatient, e.g., putting certain images in a patient's emergency folderand the rest in a general folder. As the number of images gets large,this very limited organization of the scanned images does not allow fortimely retrieval of a relevant subset by a doctor currently treating apatient. In addition, because the patient, not a medical recordstechnician, medical professional, or health service entity, selects whatis to be placed in the emergency folder, some of relevant data may beomitted. Thus this system has both the disadvantages of a veryincomplete patient history and limited usefulness of the images becausethe patient is forced to make decisions about the relevancy of certainmedical information.

[0012] A patient's health is best served by a complete or nearlycomplete set of medical records with a comprehensive organizationalstructure used throughout. In contrast, prior art systems only provide asmall subset of the patient's medical records within organizationalstructures that are likely to be inadequate to the needs and the timepressures of a healthcare provider currently diagnosing and treating thepatient: the vast majority of the patient's medical records remainfragmented over the rest of the patient's many past and presenthealthcare providers. Prior art systems which provide the ability toconsolidate a patient's medical records from the past do not providemeaningful or comprehensive organization for the patient's consolidatedmedical records. What is needed is a method and system that manages acomplete or nearly complete set of a patient's medical records thatallows easy retrieval and meaningful display of relevant information.

SUMMARY OF THE INVENTION

[0013] The present invention includes a system and a method for thecollection, organization, and distribution of a patient's medicalrecords by a central data repository under the direction of the patient.Medical records from a plurality of the patient's healthcare providers,including past and present healthcare providers, are maintained in thiscentral repository, thus providing a comprehensive, organized, andaccessible medical history of a patient.

[0014] An exemplary embodiment has a patient-directed central datarepository and a set of processes that enable the patient to be the hubin a hub-and-spoke arrangement, where each spoke goes to one of thepatient's healthcare providers, both past and present. The patient'smedical records, past and present, and any updates thereunto, from oneor more of the patient's healthcare providers are collected, classifiedand stored in the central data repository At the patient'sauthorization, healthcare providers can gain access to the centralrepository and view the patient's consolidated medical records. Thesystem which stores the records in the central data repository providesclassification schema and capabilities that enable the record pages tobe sorted and prioritized in numerous meaningful ways. The sortedmedical records and descriptive information about the entire recordcollection can be displayed to both the patient and/or the healthcareprovider currently advising and/or treating the patient and/or otherentities designated by the patient. The system also automaticallyorganizes the medical record documents in such a way that facilitatesthe generation of reports that can then be readily distributed via fax,email, hardcopy and/or CD-ROM to the patient or patient's designatedentities.

[0015] One embodiment of the present invention includes a method fororganizing patient's medical records authored by multiple healthcareproviders. Two or more documents, comprising part of the patient'smedical records, are categorized according to a categorization systemand stored in a storage area of a central repository, where access tothe central storage area must be authorized by the patient. An orderedset of the categorized documents is retrieved from the central storagearea using at least one criterion of a plurality of predeterminedcriteria. In addition the ordered set may be displayed via a Web browseror distributed in hard copy format.

[0016] Another embodiment of the present invention includes a method forselecting and sorting two or more documents from the patient's completemedical records according to selected document categories and varioussort criteria. In addition, the sorted documents can be displayed via aWeb browser rather than distributed via fax, email or hard copy format]

[0017] Another embodiment of the present invention includes a method fora patient accessing his/her own medical records originated from multiplehealthcare providers. First, the documents of the patient's medicalrecords are collected from both past and present healthcare providers.The documents are then categorized according to a categorization systemhaving more than two categories and stored in a central storage area ona computer system, where the storage area is under direct or indirectcontrol of the patient. An example of indirect control is a serviceprovider that directly controls the central storage area, but isdirected by the patient, or the patient's legal representative, on whatinformation can be viewed and accessed and by whom. Lastly, a documentis retrieved from the storage area according to a selection criterion,where the selection criterion is based on the categorization system.Optionally, the selected document is displayed to the patient or thepatient distributes the document via fax or email or directs a serviceprovider to distribute the document via fax, email, or send in hardcopyor CD-ROM format through traditional mail.

[0018] An aspect of the present invention, includes a method for apatient accessing his/her medical records originated by multiplehealthcare providers. First, the patient's medical records are collectedfrom the healthcare providers. Next, documents of the patient's medicalrecords are categorized according to a categorization system, and thecategorized documents are stored in the patient directed centralcomputer storage area. A document log of some or all of the categorizeddocuments is then displayed to the patient.

[0019] Another aspect of the present invention includes a system forcentrally managing a patient's medical records originating from multiplehealthcare providers. The system includes: a collection service modulefor collecting the patient's medical records from the healthcareproviders; a computerized categorization system for categorizing eachmedical record, where the categorization system is the same for all ofthe patient's healthcare providers; a patient directed central computerstorage area for storing the categorized medical records; and aretrieval module for retrieving ordered or sorted documents, where theordered documents are arranged using at least one criterion of two ormore criteria, where the criteria are based on the computerizedcategorization system.

[0020] Another embodiment of the present invention includes a method ofcentrally managing a patient's medical records originated by multiplehealthcare providers. First, the patient's medical records, includingpaper-based documents, are collected from the patient's past and presenthealthcare providers. Next, each page of the paper-based documents isclassified using classes of a classification system common across allthe patient's healthcare providers. Each page of the paper-baseddocuments is converted to an electronic image and stored in a computerreadable medium, where third party access to the computer readablemedium is authorized by the patient or his legal representative. Anorganized subset of said electronic images is retrieved using at leastone selection criterion of a plurality of selection criteria, anddisplayed to a patient designated entity.

[0021] In yet another embodiment of the present invention a system forcentrally managing patient's medical records originated by multiplehealthcare providers is provided. The system includes: a backend serverfor receiving the patient's medical records from the patient'shealthcare providers, where each document of the patient's medicalrecords is categorized using the backend server; a database connected tothe backend server for storing the categorized documents, where accessto the categorized documents is controlled directly or indirectly by thepatient or his legal representative; and a Web server connected to thebackend server and to a client system, where the Web server processes asearch request initiated by the client system for a select set of one ormore document(s) out of all the stored categorized documents.

[0022] A further aspect of the present invention includes a method in acomputer system for displaying a document log of the medical records ofa patient. A table is displayed that includes multiple rows, where eachrow includes multiple columns, and where a column includes one or morecells associated with a category. Document ID data, which identifies adocument in the patient's medical records, is displayed in a cell of arow.

[0023] Another aspect of the present invention includes a method, usinga computer, for commenting on a medical record by a patient. First, anelectronic image of said medical record is searched for using a categoryassigned to the medical record. The electronic image is stored in adatabase, where access to the electronic image is controlled by saidpatient. Next, a patient's comments and/or a provider's comments areassociated with the electronic image and stored in the database. Whenthe electronic image is recalled the comment is also recalled anddisplayed concurrently with the electronic image.

[0024] Another aspect of the present invention includes a method in acomputer system for displaying a document timeline of documents in apatient's medical records. A first axis is displayed having sequentialcalendar time units, and a second axis is displayed listing thedocuments organized by medical category. For a particular document,there is an indication on the first axis of a calendar time unit havingthe date of creation and the name of the author of the particulardocument.

[0025] Yet another aspect of the present invention includes a method ina computer system for displaying a progress note timeline of multipleprogress notes in a patient's medical records. A first axis is displayedindicating sequential calendar time units, and a second axis isdisplayed indicating the total number of progress notes per calendartime unit.

[0026] An embodiment of the present invention includes a method for adoctor using a patient's medical records, including clinical pages,stored in a patient directed computer storage area. First, the doctorselects a category that's of relevance from the list of multiplecategories that could be used to categorize each clinical page. Next, asubset of the clinical pages is retrieved from the computer storagearea, where the subset includes those clinical pages belonging to thecategory and not designated private by the patient. An “Availability”factor is calculated as a ratio of the number of clinical pages in thesubset to the total number of clinical pages categorized with thatcategory. Lastly, the Availability factor is displayed on the title pageunder the category for use by the doctor in evaluating the completenessof the subset.

[0027] Another embodiment of the present invention includes a method fora doctor using a patient's medical records, including clinical pagesfrom a healthcare provider, stored in a patient directed computerstorage area. First, the doctor selects a category of the multiplecategories classifying the clinical pages. Next, a subset of theclinical pages belonging to the category is retrieved from the computerstorage area. A “Source” factor is calculated as the ratio of a numberof clinical pages in the subset obtained directly from the healthcareprovider (as opposed to indirectly from the patient) to the total numberof clinical pages in the subset. The source factor is then displayed tothe doctor for use in evaluating reliability of the subset.

[0028] These and other embodiments, features, aspects and advantages ofthe invention will become better understood with regard to the followingdescription, appended claims and accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0029]FIG. 1 illustrates the fragmentation puzzle of a patient's medicalrecords of the prior art;

[0030]FIG. 2 is a block diagram of an example flow of a patient'smedical records among different healthcare providers of the prior art,that results in the fragmentation puzzle of FIG.

[0031]FIG. 3 is a block diagram illustrating the hub and spoke flow of apatient's medical records between different healthcare providers medicalrecord systems and a patient's central data repository of one embodimentof the present invention;

[0032]FIG. 4 shows the results of a consolidation of medical recordsfrom the multiple healthcare providers of FIG. 1 into a patient directedcentral data repository;

[0033]FIG. 5 is a client-server architecture of one embodiment of thepresent invention;

[0034]FIG. 6 is a flowchart for the process of managing a patient'smedical records according to an embodiment of the present invention;

[0035]FIG. 7 shows the preferred process of managing a patient's medicalrecords of another embodiment of the present invention;

[0036]FIG. 8 is an example of a user interface for entering the requestfor medical records of multiple providers (historical and current) of agiven patient;

[0037]FIG. 9 is an example of a user interface showing the collectionstatus of a patient's medical records;

[0038]FIG. 10A is an example of a user interface for a system ofcategorizing a scanned page;

[0039]FIG. 10B is an example of a user interface for a system ofcross-categorization, i.e., adding an additional category to an alreadycategorized page or making edits to the categorization of a scannedpage.

[0040]FIG. 11 shows an example of an electronic image with thecategories added to the header and footer of the scanned page from FIG.10A;

[0041]FIG. 12 is an example of a window of a physical exam summary pageof a patient's medical records;

[0042]FIG. 13 shows an example of a comment box in which the patient canenter his own comments related to the physical exam summary page of FIG.12;

[0043]FIG. 14 is an example of a document appended with patient'scomments;

[0044]FIG. 15 is an example of a page listing the medical sub-categoriesrepresenting various types of page (Page Type by Medical Category) foundin a patient's medical record file and the order of presentation ofparticular tab sections for two reports that display record pages alongthese medical sub-categories of an embodiment of the present invention;

[0045]FIG. 16 is an example of a user interface allowing the designatingof some of a patient's medical records as “Private”;

[0046]FIG. 17 is an example of a document log sorted by medicalsub-categories (page type), an aspect of the present invention;

[0047]FIG. 18 is an example of a document timeline for the documents inFIG. 17, an embodiment of the present invention;

[0048]FIG. 19 is an example of a timeline of the number of a doctor'sprogress note of an embodiment of the present invention;

[0049] FIGS. 20-1 to 20-7 show the database structure of an embodimentof the present invention.

DETAILED DESCRIPTION OF THE INVENTION

[0050] In the following description, numerous specific details are setforth to provide a more thorough description of the specific embodimentsof the invention. It is apparent, however, to one skilled in the art,that the invention may be practiced without all the specific detailsgiven below. In other instances, well known features have not beendescribed in detail so as not to obscure the invention.

[0051]FIG. 3 is a block diagram illustrating the hub and spoke flow of apatient's medical records between different healthcare providers medicalrecord systems and the patient's central data depository of oneembodiment of the present invention. The example of FIG. 3 uses the samehealthcare providers as FIG. 2. The different healthcare providermedical records systems are shown in parentheses, as the records areactually transferred from one healthcare provider system to anotherhealthcare provider system. The patient either has a central datarepository himself that he directly controls or has a service provider(or another person or organization) having a central data repository forhim, that the patient indirectly controls (i.e., the service providermust have the patient's explicit or implicit permission before any ofthe patient's medical records can be shown to a third party). Both ofthese central data repositories of a patient's medical records arecalled, herein, a patient directed central data depository 210 or“central data depository”, as the patient or his legal representativehas direct or indirect control on who has access to his medicalinformation.

[0052] In the example of FIG. 3, a patient's childhood doctor is generalpractitioner 110, e.g., a pediatrician like in FIG. 2. However, unlikeFIG. 2 the patient directed central data repository 210 does contain acomplete copy of all of the patient's medical records authored bygeneral practitioner 110. When patient 210 changes doctors to generalpractitioner 112, general practitioner 112 gets any of patient's pastmedical records, e.g., those kept by general practitioner 110, from thecentral data repository 210 rather than a past healthcare provider'smedical record system. Copies of the patient's medical records generatedby general practitioner 112 are also transferred to the central datarepository 210. When the patient goes to specialist 114, specialist 114uses the central data repository 210 for past medical records e.g.,medical records kept by general practitioner 110 or current medicalrecords, e.g., medical records kept by general practitioner 112.Similarly, when the patient changes health plans and gets a new generalpractitioner 120 and a new specialist 122, these doctors need onlyaccess the central data repository 210 to get any necessary medicalrecords of the patient. Duplications and gaps in documentation arereduced by the current doctor being able to see a list of what'savailable in this central data repository 210. Thus the hub and spokearrangement of FIG. 3 significantly simplifies the information flowgiven in FIG. 2, and significantly reduces or eliminates thefragmentation of a patient's medical records across the differenthealthcare providers.

[0053]FIG. 4 shows the results of a consolidation of medical recordsfrom the multiple healthcare providers of FIG. 1 into a patient directedcentral data repository. Besides the major advantage of having acomplete set of medical records available to the patient and hishealthcare providers, duplicate records can be removed and the variouspieces of a patient's medical history can be organized in a coherent andconsistent fashion.

[0054] While the retrieval and consolidation of a patient's medicalrecords into one central data repository is a necessary condition inusing the patient's medical history effectively, such a collection isnot sufficient. Unless the voluminous number of documents in a patient'smedical records are adequately organized and presented, there is a smallchance that a relevant subset of the collection of documents can beretrieved and displayed in a timely and relevant manner for use by adoctor currently diagnosing and treating the patient. Thus categorizingor classifying of each document in a patient's medical history isanother necessary condition in using the patient's medical historyeffectively. One or more of the categories or classes is then usedduring the retrieval to order a part of or all of the collecteddocuments, and a relevant subset for presentation is selected from theordered documents based on a filtering criteria. For example, if adoctor's notes of the collection of documents are orderedchronologically by date of creation, then only the notes over the pastyear may be displayed.

[0055] The term “document”, as used herein, comprises a text or wordprocessing file, an image file (e.g., pdf, jpeg, bmp), a page of apaper-based or electronic medical record, a film (e.g. X-Ray), a videoor audio clip, a multimedia file, or a page of any softcopy or hardcopyof information related to the patient. The term “medical” is not limitedto the medical field, but includes dental, pharmaceutical, optometric,audiological, chiropractic, physical rehabilitation, mental health,insurance and contact information relating to the patient, and/or anyother traditional or non-traditional healing fields. The term “clinical”refers to any medical information (historical or current), provider ortest-result based or information provided by the patient, that can beused as data for proper diagnosis and treatment of the patient.

[0056]FIG. 5 is a client-server architecture of one embodiment of thepresent invention. Web server 348 of server system 310 is connected viaa communications network, e.g. the Internet 312, to client systems 320,322, and 324. The server system 310 includes a backend server 340connected to a scanner 342, a printer/fax 352 and a database 344, wheredatabase 344 stores electronic copies of the patient's medical records.The backend server 340 is connected to Web server 348. A client system320 includes a personal computer (PC) 330 and a telephone 332, andprinter (not shown). The PC 330 is connected to the Web server 348 viaInternet 312. The telephone 332 is connected to a phone system interface350 via public telephone system 314. Examples of the phone systeminterface 350 include a human interface, voice recognition unit (VRU),or automatic call system (e.g., for sending automated announcements topatients about keeping their records updated at specific timeintervals.)

[0057] A patient's medical records, stored off-line in database 344, canbe accessed by a client system, e.g., 320, through a scheduled“Session”. A “session” is a time window in which the patient's medicalinformation is available for access on Web server 348. The patient orthe patient's authorized representative at, e.g., client system 320 usestelephone 332 to call phone system interface 350 to request a timewindow (e.g., start time and duration) to logon to Web server 348, andthe patient receives a Session ID from the backend server 340. TheSession ID instructs backend server 340 when, and for how longinformation is placed on-line for access. The client system 320 logs onto Web server 348 with the client's Login Name (or Member ID), password,and session ID at the given time. If the Session ID given by the clientsystem 320 is the same as the session ID given by the backend server 340to the patient via the phone system interface 350, then medicalinformation on the patient, e.g., a portion or all of a patient'smedical records, stored off-line in database 344 is transferred to atemporary storage location on Web server 348 by the backend server 340.If the session ID is incorrect or the patient logs on outside of thegiven time window, then no medical information on the patient istransferred to the Web server 348. When the patient logs off eitherexplicitly or implicitly, e.g., by not entering information for apredetermined length of time or by exceeding the time window, themedical information on the patient is deleted from the temporary storagearea on the Web server 348. 16

[0058] In one embodiment the phone system interface 350 is a call centerwhose operators use Web pages from the backend server to schedule asession for the patient. In another embodiment the phone systeminterface 350 is a phone server connected by a local network to thebackend server 340, where only the requested time window and session IDfor the patient is passed between the phone server and the backendserver 340.

[0059] Record distribution can be done directly by a patient sending anemail or fax from his client PC 330 or indirectly by calling a serviceentity by using the telephone system (332, 314, 350), which thenretrieves relevant documents from backend server 340 for distributionvia email, fax 352, CD-ROM (not shown), or hardcopy generated by printer352 and then shipped off via traditional mail

[0060]FIG. 6 is a flowchart for the process of managing a patient'smedical records according to an embodiment the present invention. Atstep 410 the documents from a patient's medical records are collectedfrom the patient's current and past healthcare providers. The documentsmay be collected in various forms to include electronic, paper-based, orfilm. For the documents that are paper-based, they are converted toelectronic images by scanner 342. Each document in the patient's medicalrecord is categorized (or classified) according to a predeterminedcategorization (or classification) system (step 412). In one embodimentall documents are converted into electronic format, except the medicalimages on film which are labeled with their categories, but notconverted into electronic format. In an alternative embodiment, thesemedical images are also converted into electronic format. At step 414,the categorized electronic documents are stored in database 344. Uponrequest of a client system 320 to Web server 348 (with the appropriatesession ID), backend server 340 retrieves and arranges some or all ofthe documents, using one or more of the categories, or retrievesinformation about the requested documents, e.g. number of documents in agiven time period, from database 344 (step 416). The arranging of thedocuments, includes a sorting process using one or more of thecategories, e.g., date of creation, and a predetermined sortingcriteria, e.g., reverse chronological order. Next a filtering process isperformed based on a predetermined filtering criterion, e.g., all of thesorted documents in the past year or all of the documents describing orlisting medications. In another embodiment the filtering is doneconcurrently with the sorting. In yet another embodiment the filteringis done before the sorting. At step 418 the filtered arranged documentsor information about the requested documents are sent via Web server 348to be displayed on PC 330 at client system 320. The filtered arrangeddocuments may also be emailed, faxed, stored in CD-ROM or printed andmailed on behalf of the patient (or for certain medical images retrievedfrom a film archive), either by page, section, or by the entire report,e.g., Combined Medical Records (CMR) report or Medical Summary (MS)report or the patient may print them for his own use using a printer(not shown) attached to a client system 330 (step 419).

[0061]FIG. 7 shows the preferred process of managing a patient's medicalrecords of another embodiment of the present invention. The process is acyclical process which receives a patient's medical records from aplurality of healthcare providers, e.g., 422-1 to 422-8 (bothindividuals 422-1 to 422-4 and organizations 422-5 to 422-8). Theprocess then produces an output of either all or a portion of a CombinedMedical Record report 424 or a Medical Summary report 426 or both thatis an organized version of some or all of a patient's medical records.This output is then made available to the patient and to one or more ofthe plurality of healthcare providers, as authorized by the patient. Thepatient 428 is the center of this process and has the final say orcontrol over which healthcare providers to request a copy of thepatient's records, and therefore whose provider records are to bestored, and whom to authorize access for viewing and/or obtaining acopy. The process is performed preferably by a service provider, whoacts on behalf of and with the permission of the patient 428. Theprocess has a number of sub-processes: collection of initial records andof updates to these records 430, storage 432, organization 434,presentation 436 and online access and other forms of distribution 438.

[0062] At collection sub-process 430, a patient's initial medicalrecords and any subsequent updates to these records are collected. Theinitial collection effort of a patient's medical records from themultiple healthcare providers consolidates a patient's medical data inone place, i.e., the patient directed central data repository, so thatthe patient's medical data can be reviewed on a comprehensive and asimportantly, consolidated basis. A search engine using predetermineddatabases locates the whereabouts of a patient's past healthcareproviders based on minimal information about provider's last name, city,and state. The healthcare provider is contacted in order to verifycontact information, request record copies, and check record collectionlogistics. The patient is provided with periodic updates on the statusof collecting his records. Each step of the collection process isautomatically tracked.

[0063] Updates to the patient's initial medical records are collected tokeep a patient's medical records current. Periodic “postcard reminders”or “email reminders” are set-up to remind the patient and his recordproviders to send in any new pages added to the patient's record sincethe previous collection. Using a database, the patient andrecord-provider are informed of the most recent type and date ofdocuments collected. “Authorization stickers” to be pasted on lab testsor exam requests are mailed so that the tests and requests can be sentin for updating a patient's records.

[0064] At storage sub-process 432, the patient's medical records,including paper-based records along with a section for Patient Inputs,are stored electronically in a patient directed central data repository,e.g., database 344. A patient's medical records are stored permanently(or for as long as the patient wants) so that they are available for usein the future by the patient, his healthcare providers, his familymembers, and current and future offspring (legacy). The paper medicalrecords are scanned into the computer, e.g., scanner 342 coupled toBackend server 340, enhanced, and orientated to give an uprightpresentation. Each scanned page is tagged with the patient's name,healthcare provider name, and file ID. In addition the patient inputshis medical information in order to give his perspective on his healthand to offer one place for his healthcare providers to view all relevantpatient-provided information. In an alternative embodiment, either thehealthcare provider or a third party scanning service has previouslyconverted the paper medical records into electronic images. As discussedbefore, each electronic image is tagged with the patient's name,record-provider name, file ID, and other useful categories.

[0065] At organization sub-process 434, the patient's medical recordsare organized across the multiple healthcare providers by pre-definedschema. This organization enables providers and patients to easily findand sort through pages of a patient's medical records. Thecategorization system is such that the same categories are used acrossthe multiple healthcare providers. Hence, a standard set of categoriesare used for the documents from the multiple healthcare providers. Thepages can be sorted by, section/categories, reverse chronological order,numerically by Document ID, alphabetically by name of therecord-provider, name of the author or name of the medicalspecialization pertaining to the author. Every page is examined andassigned one or more categories of “page type.” There are 30+categoriesfor describing the page type (or “medical category”) of a particularpage in a medical record file. These range from typical and commonlyused (such as “Labs & Cultures”, “EKGs”, “Progress Notes”), to moredetailed (multiple categories for Imaging, multiple categories forHospital Notes, multiple categories for Labs & Cultures), then to evenmore refined classifications for narrowing the scope of the page search(such as difference between typed and un-typed notes; difference between“Inpatient” or “Outpatient” visits for doctor's or consultative notes.).In addition to these medical sub-categories (“Page Type”), there areseveral other indices used to categorize a page including: Patient Name,Member ID, Document ID, Author Name, Author Date, Author Specialization(to the extent that the author is a doctor), and Record-Provider Name.

[0066] At the presentation sub-process 436, some or all of a patient'smedical record information is presented in reports. The presentation ofthe patient's medical information is consistent across the multipleproviders in order to enable ease of use and understanding. The two mainreports, i.e., the Combined Medical Records (CMR) and the MedicalSummary (MS) reports, include most or all of the following presentationfeatures: patient comment boxes, patient input forms, selected clinicalpages (for the Medical Summary), patient-added pages (additional recordpages to be extracted from patient's CMR and inserted into MS report forpresentation), record indicators (availability factor and source factorcalculated by algorithmic rules), document logs (by date, page type, andspecialization), and visual time lines (timeline of documents andtimeline of progress notes).

[0067] At access/distribution sub-process 438, on-line access by patienthimself or by patient-authorized third party to a patient's medicalrecords via an Internet browser is also provided. Online access enablesaccess and availability of a patient's medical records when they areneeded, and anywhere where there is Internet connection. For standard(non-emergency) access, the security and access protocols are based onan approach from a risk management standpoint, which limits the amountand length of time a patient's data can be accessed via the Internet.The access protocol limits exposure of data to unauthorized access bycontrolling the amount of data made available and when the data isaccessible via the Internet. For emergency access, the scope of contentin the patient's medical records is limited for unknown (undesignated)3rd party healthcare providers.

[0068] Further at access/distribution sub-process 438, a patientdistributes some or all of his medical records to third parties whereneeded. Distribution requires a patient's authorization on a “Send To”form before distribution can begin. The Medical Summary and/or CombinedMedical Records report can be distributed in several formats, including:individual pages, sections, or the entire report copy. Patients can makedistribution requests from their personal pages on the web server or bytelephone, fax, email, or mail. Distribution can be made by, but is notrestricted to, fax, email, CD-ROM, paper copy, or a bound copy.

[0069] Examining FIG. 7 in more detail, collection sub-process 430requires the identity and address of the healthcare provider, before apatient's medical records can be collected from that healthcareprovider. Once the identity and address of the healthcare provider isknown, server system 310 automatically generates a letter for thepatient's signature to request a copy of the patient's medical recordsfrom the physician or health-care provider organization.

[0070]FIG. 8 is an example of a user interface for a healthcare providersearch engine of an embodiment of the present invention. In thepreferred embodiment, this search engine is used by the service providerin the collection sub-process to locate the patient's healthcareprovider. In an alternative embodiment, the search engine is astand-alone that can be used to locate any healthcare provider. The userinterface 512 executes on a Web browser 510, that is displayed on clientsystem PC 330. The user interface 512 allows the patient to fill inpartial information about a current or past healthcare provider, forexample, the patient could provide some minimum information such as adoctor's last name (or organization name), city, state, and specialty,and the search engine, executing on Web server 348, searches severaldatabases to locate the rest of the doctor's (or organization's)location information. User interface 512 includes a selection 520 tochoose the type of healthcare provider, e.g., a doctor, an input area522 to enter the name of the physician or health-care organization,e.g., Jane Doe, M.D., and a selection 524 to choose the specializationof the physician or organization. User interface 512 further includesseveral address input areas, 526, 527, 528, 530, and 532 to enter thecurrent address of the doctor or health-care organization. Typically,the required address entries are for the city 528, e.g., Any City, andstate 530, e.g., CA, or alternately, the zip code 532, e.g., 92930. Userinterface 512 further includes entry areas for the office phone 534 andfor the approximate date of the first appointment 536. There is aselection button 538, that when selected, automatically searches aplurality of predetermined databases to fill in the rest of the locationinformation, e.g., address 526 and 527 of the physician or organization.Table 1 below gives examples of web sites that the search enginesearches to find the missing location information. In an alternativeembodiment the search of the Website in Table 1 is done manually. Inanother embodiment the research for locating the provider is done usingnon-Web resources. TABLE 1 http://www.docboard.org/http://www.ama-assn.org/aps/amahg.htmhttp://www.chiropractor-directory.com/http://www.theinternetdirectories.com/thehealthcaredirectory/http://www.sermed.com/hospital.htmhttp://www.nationalhospital.com/index.htmlhttp://www.hospitalselect.com/curb_db/owa/sp_hospselect.mainhttp://neuro-www2.mgh.harvard.edu/hospitalwebusa.htmlhttp://www.thephysiciansdirectory.com/http://www.thedentistdirectory.com/

[0071] After contact information in FIG. 8 is either filled in by theuser or by the search system, a request for the patient's medicalrecords from the Physician/Organization 522 is created. Next, aCollection Request ID is assigned to the request along with inputs forspecific record fields identified by the Collection Request ID, theMember's (i.e., patient's) ID, the information from FIG. 8, the date ofthe request and the status of the request is inserted into theCollectRecords table of the database 344.

[0072] The collection process can be in one of the several states,including: 1. Record collection request received, waiting forauthorization form from member (i.e., patient); 2. Authorization formreceived records requested from provider; 3. Records not received fromprovider, second request sent; 4. No response to second record request,third request sent; 5. No response to third record request, reviewoptions with member; 6. Records received, waiting to be processed; and7. Records processed into database. The current collection status isupdated by personnel of the central data repository service via a windowsimilar to window 510, but with an extra pull-down menu that allows oneof the above seven status states to be selected or updated.

[0073]FIG. 9 is an example of a user interface showing the collectionstatus of a patient's medical records. The display 550 includes thewindow 552 (Member Administration) that has the record status. In column554 is the collection request ID for each request. In column 556 is thename of the organization or physician to whom the record request issent, for example, “Cameron Medical Center” in box 570. Also the “Edit”link in box 570 brings up a window for “Cameron Medical Center” similarto FIG. 8, and allows the information in FIG. 8 to be changed. Column558 displays whether or not the search engine was used to fill inmissing contact information in FIG. 8. Col. 560 gives the date therecord collection began. Column 562 gives which of the seven states,listed above, the present collection status is in. Column 564 hascomments related to collection of the medical record.

[0074] Once the patient's medical records are received, every documentis examined and categorized (organization sub-process 434). For paperbased medical records, each page is scanned via scanner 342 into anelectronic image, stored in TIFF format, and then converted into PDFformat, once categorization is done. Each electronic image is examinedand categorized. Among the categories assigned is a page category thathas a plurality of medical sub-categories. These medical sub-categoriesinclude, for example, documents on typical medical results and notes,such as a “Labs & Cultures” sub-category, a “Consultations”sub-category, a “EKGs” sub-category, and a doctor's “Progress Notes”sub-category. Some pages could have multiple medical sub-categories(cross-referenced). The “Immunizations” sub-category, for example, hasdocuments that are also found in the “Progress Notes” sub-category andin “Physical Exams” sub-category. In an alternative embodiment, some orall of the paper-based records have been previously scanned at thehealthcare provider and these scanned image files are examined andcategorized, i.e., no scanning is needed by the server system 310.

[0075]FIG. 10A is an example of a user interface for categorizing ascanned page of an embodiment of the present invention. The scanned pageshown in window 714 is of a medication summary of patient Mary JaneAdams. Window 712 is used to assign categories to the scanned page inwindow 714. Window 712 includes an entry area 720 for the author of thescanned page, a menu 722 to select the specialty of the author given inentry area 720, menus 724 to enter the date the author generated thepaper-based page, and a menu 726 to give the page type, i.e., medicalsub-category as listed in FIG. 15, and cross-indexed (given analternative page type), where it makes sense.

[0076] When the information in FIG. 10A is submitted to the Backendserver 340, a Document ID is assigned to the scanned page and theDocument ID, the information from FIG. 9, the Collection Request ID, theMember's ID, the Record-Provider's Name, and the date the record wasentered is inserted as a record into the DocumentLog table of thedatabase 344. The scanned page is formatted into a PDF format file witha header and a footer having labels of one or more categories. Theformatted file is stored as an electronic image file (for example FIG.11) with the Document ID as the filename and a .pdf extension.

[0077]FIG. 10B is an example of a user interface for a system ofcross-indexing, i.e., adding an additional category to an alreadycategorized page or making edits to the categorization of a scannedpage. Selection 734 allows other medical sub-categories as given in FIG.15 to be added as classifying categories for the page 714, i.e.,cross-indexing. These additional medical sub-categories can be used tosearch and sort the page 714. There is also the choice 736 to make editsto the author 740, date 742, or specialization 744 of an alreadycategorized page 714. Also selection 738 allows deleting a page that hasbeen duplicated for cross-indexing purposes.

[0078]FIG. 11 shows an example of an electronic image 810 with thecategories added to the header 814 and footer 816 of scanned page 714 ofFIG. 10A. The categories shown in this example in the header 814,include: the document identifier, “Document ID: 455” 820, the page type(medical subcategory), “Medication and Allergies” 822, the patient'sname, “Mary Jane Adams” 824, and the patient's member identifier,“MemberID 532” 826. In the footer 816 the categories shown include: theauthor of this page, “Author: Jane Doe, M.D.” 830, the doctor'sspecialization, “Specialization: Internal Medicine/FamilyPractice/Primary Care” 832, the date the author created the document,“Author Date: May 18, 2000” 834, and the name and number of the serviceprovider, “Peoplechart (415)-362-8800”. In addition any hardcopy of anyelectronic image is also labeled with these descriptive fields in theheader and footer. Hence pages can be easily traced back to a particularfile or section, date, or record provider name, and re-ordered when theybecome disorganized.

[0079] In one embodiment the categories for the header that appear oneach page include: Document ID, Patient Name, Page type(s), andPatient's Member ID. And the categories for the footer of each pageinclude Author of the page, Specialization of the Author, if relevant,Date in which page content was created, and optionally, the serviceprovider's phone number. A category that does not but could appear onthe example page is the name of the record-provider who provided therecords. In most cases, this can be an important organizational tool forthose patients who see multiple healthcare providers and want to findthe pages that belong to a particular healthcare provider. In otherembodiments some of the information in the header may be absent or inthe footer and some of information in the footer may be absent or in theheader. In an alternative embodiment, other categories may be added tothe header or footer, such as patient aliases, maiden name, patient'sdate of birth, healthcare provider, or additional categories apparent toone with ordinary skill in the arts.

[0080] A patient and/or the patient's doctor(s) can add comments to theelectronic copy of their medical records by launching a comments dialogbox. The comments then become an integral part of the medical record,i.e., the comments are electronically linked to the medical record. Thisprovides the patient with a valuable tool to update, correct and add tothe informational contents of the medical record. FIG. 12 is an exampleof a window 720 of a physical exam page 722 of a patient's medicalrecords. The comments link 721 in FIG. 12 is used to launch the commentsdialog box. FIG. 13 shows an example of a comment box 724 in which thepatient can enter his own comments related to the physical exam summarypage 722 of FIG. 12. In this example the patient types “the commentsentered here will be appended to this clinical page”. When the“Add/Update Comment” button 726 is clicked the comment is appended (orlinked) to the medication summary page 722.

[0081]FIG. 14 is an example of a record page document with a patient'scomments appended to it. Page 732 is the physical exam page 722 of FIG.12. The comment page 734, which is attached or linked to the physicalexam page 722, has the comments typed in comment box 724 of FIG. 13.

[0082]FIG. 15 lists the medical sub-categories describing page typecategory of an embodiment of the present invention. In this examplethere are 35 medical sub-categories associated with the page typecategory as shown by “Index ID”, column 912. The table 910 in FIG. 15includes a column 920 having a description of each medical sub-category,and a column 922 for the code used for each sub-category. Also includedin table 910 is a column 914 showing the sub-sections in the “ClinicalPages” section of the Combined Medical Records (CMR) report; a column916 showing the section numbers for the document timeline graph; and acolumn 918 showing the sub-section numbers of the “Selected ClinicalPages” section for the Medical Summary (MS) report.

[0083] Some of the medical sub-categories in FIG. 15 have been brokendown from a more general sub-category in order to help a doctor findinformation quickly, including 6 sub-categories for Imaging, 5 differentsub-categories of Hospital Notes, and 3 different sub-categories of Labs& Cultures. There are also sub-categories for helping patients anddoctors to quickly select or differentiate the pages they want withinthose categories, such as Typed versus Untyped (handwritten). There arealso 5 categories of “Other” to address and separate duplicate pages,irrelevant pages such as those concerning a different patient, titlepages from healthcare provider files, and administration type pages.Thus all documents of a patient's medical history are categorized withat least one medical sub-category given in FIG. 15. The categories givenin FIG. 15 are not to be interpreted as limiting, but are a preferredembodiment of the present invention. Other embodiments may havedifferent categories or the same or a different number of categories.For example, The “Medications and Allergies” sub-category could befurther divided into traditional and non-traditional medications.

[0084] Once the categorized documents are stored in database 344, thesecategorized documents can be sorted and/or searched. Pages can be foundin a selected category or sub-category by using “Search By” categoryfields displayed on a client system, e.g., client's personal computer330. Moreover, pages can be re-categorized into different categories atthe request of the patient. The categorized documents can also be sortedinto a tabbed collection of documents and presented as a report, e.g.,the Combined Medical Records (CMR) or Medical Summary (MS) report, asdescribed with tab names displayed in the order of prioritization asshown on 914 and 918 (FIG. 15), respectively. These reports are eitherpresented on the client system, e.g. 320, using a Web browser connectedto Web server 348, emailed as an attachment, faxed, saved on a CD-ROM orprinted, or both.

[0085] The Combined Medical Records report is an organized andcomprehensive portfolio of a patient's medical history. The CMR includesboth clinical record pages collected and compiled from a patient'scurrent and past healthcare providers and a section called PatientInputs, which provides an opportunity for patients to add theirperspective and assessment of their health history, condition, andobjectives. The CMR further includes organizational tools such asdocument logs, providing a page-by-page inventory of the medical recordsin the patient's files and a time line of activities represented bydocuments collected over the course of a patient's health history. Anexample of a CMR outline by section and sub-section is given in Table 2below. TABLE 2 SECTION SUB-SECTION A. Table of Contents B. PatientInputs C. Document Logs  1. By Date  2. By Medical Category  3. BySpecialty D. Document Timeline E. Clinical Pages  1. Medications &Allergies  2. Immunizations  3. Patient Intake  4. Physical Exams  5.Progress Notes  6. Consultations  7. Operative Notes  8. ER Reports  9.Hospital Summaries 10. EKGs 11. Imaging Reports 12. Special Tests 13.Labs & Cultures 14. Therapy Notes 15. Billing & Insurance 16. Other

[0086] A patient may designate any document in his medical records as“Private”. These “Private” documents are only viewable by the patientand are not included in the CMR or MS reports. If the patient wants toprovide “Private” documents to another party, this can be done on a perdocument basis.

[0087]FIG. 16 is an example of a user interface 930 allowing thedesignating of some of a patient's medical records as “Private”. FIG. 16has information in its columns similar to FIG. 17, except there is a“Private” column 932, that allows a patient to select which documents incolumn 954 are to be designated “Private”. After the patient checks thecheckboxes, e.g., checkbox 934, of the private documents, he clicks thebutton “Hide Private” 936 to complete the hiding process, i.e., only thepatient can view the private documents. Hiding Document 455 (checkbox934) means that the information relating to Document 455 will not appearin the document logs, timelines, or reports as illustrated in FIG. 17and FIG. 18.

[0088] Both the CMR and MS reports have record indicators to inform thedoctor whether some of the patient's medical records are missing fromthe report, i.e., marked “Private” in the database. Another recordindicator that informs the doctor whether the clinical pages wereprovided by another healthcare provider or by the patient. Theseindicators assist the doctors in determining the reliability of themedical records.

[0089] “Availability” factors are calculated and displayed for eachsub-section of the clinical page section of the CMR and for the wholereport. These factors are also applicable to each sub-section of theselected clinical pages of the MS. The availability factor is the ratioof the number of pages presented in the report to the total number ofpages collected, by section and by entire report. This indicates to thephysician whether some pages have been classified as Private and are notavailable for viewing. For example, an availability factor of 75% on asubsection of four documents means for example, that 3 out of the 4documents in the subsection are included in the sub-section, while onedocument has been excluded from the presentation or marked as “Private.”

[0090] “Source” factors help measure the classification of the source,individual or organization who sent in the records, for each sub-sectionof the clinical pages in the CMR and for the whole report, i.e., thoserecords provided or sent in by a patient versus those records sent in orprovided by provider. Since many physicians are concerned that they havea complete set of records, they assess the credibility of these recordsby the source-sender of the records, i.e., whether the records have beenobtained directly from a healthcare provider or indirectly from thepatient. This information is provided as a ratio of the number ofclinical pages in a medical sub-category obtained directly fromhealthcare providers to the total number of pages in this medicalsub-category. A source factor of 90% in a subcategory having ten pageswould indicate that nine pages came directly to the data repositoryservice from the healthcare provider, and one page came from thepatient.

[0091] After the “Table of Contents” section, the next section in theCMR is the “Patient Input” section. The patient input section allows apatient to share his perspective of his health with his doctor. Thissection includes: a patient's assessment of his health history, currenthealth condition, and objectives; clinical information that the patienthimself fills in order to supplement his medical records, such asmedications, immunizations, and allergic reactions; and personal andmedical contact information, health insurance, and administrativeinformation. The patient input section includes two major partscompleted by the patient. Part I provides the patient's personal andmedical information, description of health statistics, family history,and assessment of his health conditions. Part II provides medical andpersonal contacts for times of medical emergencies and other relevantadministrative information.

[0092] The Part I, Health Assessment, is further divided into: personalinformation, current health concerns, health history, allergies &reactions, medications, doctors be aware, general health & background(including immunizations), hospitalization history, family healthhistory, alternative/complementary medicine, and health objectives &experience. Part II, Personal Contacts and Administrative Information,is further divided into: doctor contact information, emergency contactinformation, employment information, and health insurance.

[0093] The third section in the CMR is the “Document Logs” section.Document logs provide an inventory listing of every page contained in apatient's collected medical records. This list can help the patient andher doctor spot a specific clinical page or review the amount, type, andtiming of clinical documents available in the patient's files. Pages maybe sorted by sub-categories, for example: 1) Document ID#, 2) Documentdate, 3) Record-provider name, 4) Page type by medical sub-category, 5)Author of the document and 6) specialization of the author. In oneembodiment, the CMR documents are sorted by the document date, bymedical subcategory, and by doctor specialization to produce threedifferent logs.

[0094] A document log sorted by date, provides an inventory of pages ina patient's compiled records, presented in reversed chronological orderbased on the date shown for creation of the page content. When adocument cannot be dated based on information from the page, a defaultdate is chosen that places the document at the end of the log. Withdefault dates, the patient is advised to review and provide a date ifknown or available. When a document has multiple dates listed on thepage, such as pages found in Progress Notes or Medication Refill Logs,the most recent date is chosen. However, due to the fact that there areusually multiple dates for Progress Notes, pages of this type are shownseparately in its own Timeline table.

[0095] A Document log sorted by medical category provides an inventoryof pages in a patient's compiled records, organized by sections made upof commonly used medical sub-categories such as medications & allergies;hospital summaries; labs & cultures; etc. (see FIG. 15). Within eachsub-category, pages are sorted in reversed chronological order. When adocument cannot be placed in a specific medical sub-category, it isplaced in a sub-category labeled “Other: Unclassified” and placed at theend of the log.

[0096] A document log sorted by specialization organizes the pages basedon the specialty of the doctor or provider who wrote or created eachpage. This log provides an inventory of pages in a patient's compiledrecords, organized by name of the specialty of the physician(s) whoauthored the pages. The ability to sort charts by specialty helpspatients bring information that is most relevant to their doctors,especially when they see a specialist about a particular condition.Pages authored by a location or an organization (such as a health clinicor laboratory) can be difficult to classify into specialties and areleft for the patients or their doctors to categorize by relevantspecialty. A document which cannot be categorized by specialty of authoris included in a category labeled, “Unknown Specialty” and placed at theend of the log.

[0097] While the CMR provides three logs, other document logs based onthe other categories can be generated and displayed. FIG. 17 is anexample of a document log sorted by medical sub-category of anembodiment of the present invention. The window 952 includes thedocument log sorted by the medical sub-categories of FIG. 15. Column 954gives the document ID for each document. Cell 970 has document ID 456,which is a link to the document image, e.g., the scanned image of thepage (while document ID 455 (as selected by checkbox 934) is hidden fromview as a result of having clicked on “Hide Private” button as describedon FIG. 16). When “456” is selected a separate window (not shown) openswith the document's image. The four cells 972 have document IDs 457,458, 459, and 460, which all have the same date 974, i.e., “Jun. 15,1999” and the same page type “Physical Exams” 978. The window 952further includes, column 956 which has the date the document wascreated, column 958 has the healthcare provider that provided thedocument, column 960, “Page Category” and the primary “Sort Key” in thisexample, has the medical sub-category from FIG. 15, column 962 has thename of the doctor who created the document, and column 964 has thespecialization of the doctor in column 962.

[0098] The fourth section in the CMR is the “Document Timeline” section.A timeline shows the pattern of events in the course of a patient'smedical history by tracking the number of documents collected over timeby sections made up of commonly used medical sub-categories (see FIG.15) such as medications & allergies; physical exams, hospital summaries;labs & cultures; EKGs; imaging reports; and consultations with doctors,etc. Within each medical sub-category of the timeline, each mark on thetimeline is identified by its unique combination of creation date andcreator name (author). For each sub-category, each individual mark onthe timeline can represent one or more pages that have the same date andauthor. Said another way, document that is made up of multiple pages(such as lab results) share only one mark on the timeline. The patientand doctor can visually gauge the type and frequency of activitiesperformed by reviewing the number of “X's” that document(s) collectedover the course of the patient's medical history by medicalsub-category. Both patient's and doctor's comments about the timelineare provided at the end of section.

[0099]FIG. 18 is an example of a document timeline for FIG. 17 of anembodiment of the present invention. Window 1012 includes a column 1020having the Document ID, column 1022 having the author of the document,column 1024 having the date the document was created, and a time linedivided by months, e.g., the 12 months for year 2000 1026 and the 12months for year 1999. In addition, the window 1012 shows severalsections, e.g., a “Medication & Allergies” section 1040, that includesdocument ID 456 in cell 1030 (while document ID 455 (as selected bycheckbox 934) is hidden from view as a result of having clicked the“Hide Private” button 936 as described in FIG. 16), and a “PhysicalExams” section 1040, that includes document IDs 460, 457, 458, 459 incell 1032, since they all have the same date “Jun. 15, 1999” 1034 andsame author “Jane Doe, M.D.” 1035, these documents get one mark only,1038. For document ID 456 (cell 1030), there is mark 1036 on thetimeline. For document IDs 460, 457, 458, 459 (cell 1032) there is mark1038 on the timeline. FIG. 19 is an example of a timeline of the numberof a doctor's progress note of an embodiment of the present invention.The timeline 1110 has the number of progress notes on the y-axis 1112and the time, e.g., month, on thex-axis 1114. For example, in June 1116there were two progress notes written 1118. The timeline 1110 issegmented by years, 1120, 1122, 1124, 1126, and 1128. A table 1130 listsactual dates in the month the progress notes were written. Table 1130 isalso segmented by year 1132, 1134, 1136, 1138, and 1140 to correspond toyears 1120, 1122, 1124, 1126, and 1128 of timeline 1110, respectively.The progress notes may be color coded to represent the differentproviders who authored the notes.

[0100] The fifth section in the CMR is the “Clinical Pages” section.Medical record documents collected from a patient's past and presentdoctors are arranged into commonly used medical sub-categories (FIG.15), and sorted by date in reverse chronological order. The sub-sectionsof the CMR for the “Clinical Pages” section are listed in Table 2 above.

[0101] Sub-section 1. The Medications & Allergies sub-section of the“Clinical Pages” section includes refill logs, medication notes, anypages in progress notes section referencing medications, and any pagesin physical exams section referencing medications. This sub-section canbe cross-referenced to the patient input sub-sections for allergies andreactions and medications. In one embodiment the cross-reference is donemanually by the patient's doctor or medical records technician. In analternative embodiment, there is a “cross-referenced” button on thedisplay window so that a page can appear in multiple sub-sections of theCMR and Medical Summary Report. The cross referencing is done by theservice provider. In an alternative embodiment the cross referencing maybe done by the patient and/or healthcare provider.

[0102] Sub-section 2. The Immunizations sub-section includesdocumentation of immunization given to the patient. Pages may becross-referenced to the progress notes, physical exams sub-sections, andto the general health & background of the patient input section.

[0103] Sub-section 3. The Patient Intake Applications sub-sectionincludes an application usually filled out by patient during a firstvisit with a doctor.

[0104] Sub-section 4. The Physical Exams sub-section includes notes(typed or handwritten) related to patient during a physical examination.

[0105] Sub-section 5. The Progress Notes sub-section includes notes froma first visit and any subsequent outpatient visits with the patient'sdoctors.

[0106] Sub-section 6. The Consultations sub-section includes physicianconsultation notes from any outpatient setting.

[0107] Sub-section 7. The Operative Notes sub-section includes notesrelated to both inpatient and outpatient procedures, surgeries, andoperations, performed in clinics or hospitals.

[0108] Sub-section 8. The ER Reports sub-section includes notes fromvisits to emergency rooms of hospitals or clinics.

[0109] Sub-section 9. The Hospital Summaries sub-section includesin-patient notes and consultations taken during patient'shospitalization, such as Admitting History & Physical, DischargeSummary, Consultations (Inpatient), Progress Notes (Inpatient), and anyother hospital notes. Surgical, operative and procedure reports andnotes, which are found in Operative Notes sub-section are excluded. Alsoany outpatient visits to clinics or hospitals, which are found inConsultations, Progress Notes, or Physical Exams sub-sections areexcluded. Lab results and EKG's done in hospitals are excluded and foundin the EKG and Labs & Cultures sub-section. In an alternativeembodiment, the above excluded information is cross-referenced to theappropriate sub-sections.

[0110] Sub-section 10. The EKGs sub-section includes Electrocardiogram,ECG, or rhythm strips.

[0111] Sub-section 11. The Imaging Reports sub-section includes scansand ultrasounds including the following imaging results: X-Rays,Ultrasounds, Mammograms, CAT or CT scans, MRI scans, Nuclear medicinescans, DEXA (bone density) scans, PET scans and any other imaging testresults.

[0112] Sub-section 12. The Special Tests sub-section includes any teststhat are non-EKG and non-imaging related, such as: ECHO-Cardiograms,Cardiac stress tests, Treadmill tests, Pulmonary Function tests,Dobutamine or Persantine stress tests, MUGAs, and any other specializedtest results.

[0113] Sub-section 13. The Labs & Cultures sub-section includes: Bloodchemistries, complete blood counts, protimes and other tests ofcoagulation, arterial blood gases, urinalysis and urine chemistries,lipids, serologic tests, HIV tests (provided with patient'sauthorization), culture & sensitivities (including urine, sputum, blood,etc.), pathology reports, and any other lab or culture results.

[0114] Sub-section 14. The Therapy Notes sub-section includes any kindof log or notes pertaining to any kind of ongoing or periodic therapy ortreatment, such as physical therapy, occupational therapy, radiationtherapy, chemotherapy, any other therapy notes.

[0115] Sub-section 15. The Billing & Insurance sub-section includescopies of insurance cards and other information related to billing,insurance, and payment.

[0116] Sub-section 16. The Other sub-section includes record releaseforms, duplicate, irrelevant, misfiled, section, title, blank, andadministrative pages that are not billing, insurance, or prescriptionrelated. Other administrative pages can include patient-sent orinitiated letters, correspondences, forms, phone logs, record releaseforms.

[0117] The Medical Summary (MS) report enables both patient and doctorto quickly review a patient's medical condition and history both inmedical emergency and in less urgent but time sensitive situations suchas a first visit to a new doctor. It includes clinical record pagesselected from a patient's combined medical record file. The section andsub-sections are given in Table 3 below. TABLE 3 SECTION SUB-SECTION A.Table of Contents B. Patient Inputs C. Document Log  1. By Date  2. ByType  3. By Specialty E. Select Clinical Pages  1. Medications &Allergies  2. Immunizations  3. Physical Exams  4. Progress Notes  5.Consultations  6. Operative Notes  7. ER Reports  8. Hospital Summaries 9. EKGs 10. Imaging Reports 11. Special Tests 12. Labs & Cultures 13.Therapy Notes 14. Patient Added Pages

[0118] The first three sections, Table of Contents, Patient Inputs, andDocument Log are the same as those in CMR. The “Select Clinical Pages”sub-section however has specific record pages from the CMR organizedinto sub-sections based on commonly used medical categories (the MSsub-sections are given in FIG. 15 column 918). For all sub-sections,pages included in each sub-section are automatically drawn from apatient's Combined Medical Records using a formula. The formula includesall documents with document creation dates within the N1 months prior toand including the patient's most recent date of activity for thespecific sub-category or a minimum of M1 documents (regardless of time)each with an unique combination of creation date and creator name(author), which ever is greater. In one embodiment N1=12 and M1=3, butN1 and M1 can be any integer numbers. This formula is automatic andcaptures the most recent pages. However, other embodiments can use adifferent formula. For example the availability factor can be used tochange the order of some documents with the most recent and mostavailable being first.

[0119] In another embodiment, the first step in generating the group ofselected clinical pages for each sub-section of the MS from the CMR isto retrieve from the DocumentLog table of the database the date of themost recent clinical page for the specified sub-section and targetpatient. In the second step, the number of Private clinical pages(clinical pages that the patient has designated to be viewable by thepatient and no one else), the number of patient-provided clinical pages(clinical pages obtained directly from the patient rather than directlyfrom a healthcare provider), and the total number of clinical pages withauthor (doctor/organization) creation dates within N2 months prior toand inclusive of the most recent clinical page obtained in the firststep above, are obtained from the database. If the second stepidentifies less than M2 number of clinical pages, the next most recentclinical documents (i.e., over one year of the most recent clinicalpage) are added to the group so that there are at least M2 unique set ofdocuments presented in the group. In an embodiment N2=12 and M2=3, butN2 and M2 can be any integer numbers. Next, the Availability and Sourcefactors are calculated. The selected clinical pages in the presentationgroup are now retrieved from the database in reverse chronological orderfor the specified sub-section. This process is repeated for eachsub-section of the “Select Clinical Pages” section.

[0120] The “Selected Clinical Pages” has sub-sections given in Table 3above, and except for a new “Patient Added Pages” sub-section, is asubset of the sub-sections given for the “Clinical Pages” section of theCMR listed in Table 2 above.

[0121] The “Patient Added Pages” sub-section includes any clinical pagesfrom the CMR that a patient would view as important to include in theMedical Summary. These pages are usually those pages that fall outsidethe range set by the automated formula for extracting selected recordpages from the CMR.

[0122] In one embodiment of the present invention there are two flexibleaccess plans for third parties having on-line access to a patient'smedical records: emergency and non-emergency access.

[0123] In the case of a medical emergency, a healthcare provider canview the telephone number on the patient's membership card to call thephone server 350 (FIG. 5) with the patient's “Member ID”. The amount ofaccess given to the emergency healthcare provider has been pre-selectedby the patient to be one of several possible Emergency Access levels. Inone embodiment these could be Private (where no information isprovided); Contact Information Only (where only contact information forreaching the patient's doctor(s) and/or family members or next-of-kinare made available; Medication and Contacts Only (where medicationdescriptions and medication lists are added to contact information); andFull Access (where record pages from Combined Medical Records or MedicalSummary are made available (except pages member classified as“Private”).

[0124] Under non-emergency, i.e., normal situations, a patient selectswhat type of access to give to a third party, such as his doctor, inacessing his medical information. There may be various levels of accessfor a patient and potentially third-parties authorized by the patient.The access in one embodiment is set using a password protected Web page.The levels in one embodiment are given in Table 4 below. TABLE 4 AccessRights Assign (create) Schedule Edit patient's View new users a specificrecords and patient's to access time for viewing distribute classifiedAccess patient's patient's medical records to “Private” Levels account?records online? another party? pages? Patient YES YES YES YES SurrogateYES YES YES NO Provider NO YES NO NO Limited NO NO (*) NO NO

[0125] The patient or his legal surrogate decides and authorizes thedistribution of all or part of the patient's medical records to one ormore third parties. A patient can transmit, via email or fax, a medicalrecord or a group of medical records directly by using her web browser.Off-line distribution service is provided only with a patient's, legalsurrogate or guardian's signed authorization on a “Send To”Authorization Form. There are several media which the whole or portionof a patient's CMR or MS report can be distributed by, to include: fax,email, CD-ROM, DVD, paper copy, or microfiche.

[0126] FIGS. 20-1 to 20-7 show the database structure 1410 of anembodiment of the present invention. The off-page connectors are givenby the letters “a” through “w”. The legend 1412 in FIG. 20-1 explainsthat “PK” is a primary key, “FK” is a foreign key, and “I” is indexed(i.e., an index structure is used to access records in a file). While inlegend 1412, “bold” text indicates a required attribute and “normal”text indicates an optional attribute in this embodiment, otherembodiments have different combinations of required and optionalattributes. An example of an entity set is “ClientDir” entity 1420(i.e., the set of clients or patients) which has a primary key of“ClientIDX” (i.e., the client ID) 1422, and several attributes, e.g.,“LastName” 1424 (i.e., the client's last name). A particular value of“ClientIDX” 1422 can be used to determine the client's (i.e., patient's)physician, by using the foreign key “ClientIDX” 1442 in “Physician”entity set 1440 in FIG. 20-5, to retrieve attribute “LastName” 1444 ofthe entity (i.e., a particular doctor) in the “Physician” entity set1440 with the particular value of “ClientIDX” (i.e., the last name ofthe patient's doctor). The off page connector “p” from entity set 1440terminates in ClientDir entity 1420 indicating the foreign keyrelationship. In addition, the particular value of “ClientIDX” can beused to search entity set “DocumentLog” 1450 (i.e., the set of documentlogs) to get the “DocumentIDX” 1454 (e.g., Document ID #) for eachdocument associated with the client with the particular value of“ClientIDX” (i.e., the document IDs of the documents in a patient'smedical records). The off page connector “t” from entity set 1450terminates in ClientDir entity 1420 indicating the foreign keyrelationship.

[0127] While the embodiments given herein describe management of apatient's medical records, the scope of the present invention is not solimited but, includes other types of records where a person needshis/her records collected, categorized, stored (under his/herdirection), and presented (e.g., displayed or distributed). Such othertype of records include tax documents, wills, personal letters, legalpapers, licensing/ownership papers, bills, payments, investments, andother personal information.

[0128] Although specific embodiments of the invention have beendescribed, various modifications, alterations, alternativeconstructions, and equivalents are also encompassed within the scope ofthe invention. The described invention is not restricted to operationwithin certain specific data processing environments, but is free tooperate within a plurality of data processing environments.Additionally, although the invention has been described using aparticular series of transactions and steps, it should be apparent tothose skilled in the art that the scope of the invention is not limitedto the described series of transactions and steps.

[0129] Further, while the invention has been described using aparticular combination of hardware and software, it should be recognizedthat other combinations of hardware and software are also within thescope of the invention. The invention may be implemented only inhardware or only in software or using combinations thereof.

[0130] The specification and drawings are, accordingly, to be regardedin an illustrative rather than a restrictive sense. It will, however, beevident that additions, subtractions, deletions, and other modificationsand changes may be made thereunto without departing from the broaderspirit and scope of the invention as set forth in the claims.

What is claimed is:
 1. A method for managing a patient's medical recordsauthored by a plurality of healthcare providers, wherein at least twohealthcare providers of said plurality have different medical recordssystems, said method comprising: categorizing a plurality of documentsof said patient's medical records according to a categorization system;storing in a central storage area said categorized plurality ofdocuments, wherein access to said central storage area must beauthorized by said patient; and retrieving an ordered set of documentsof said categorized plurality of documents, using at least one of aplurality of predetermined criteria.
 2. The method of claim 1 whereinsaid central storage area comprises a database.
 3. The method of claim 1wherein said plurality of predetermined criteria include sorting saidcategorized plurality of documents in reverse chronological order ofcreation dates, by medical sub-category, by author, by authorspecialization, in numerical order of document ID, by document provider,or any combination thereof.
 4. The method of claim 1 further comprising:sorting said plurality of documents; and presenting said sortedplurality of documents based on a selection criterion and aprioritization algorithm.
 5. The method of claim 1 further comprisingdisplaying said ordered set of documents to a current healthcareprovider examining said patient.
 6. The method of claim 5 wherein saiddisplaying said ordered set of documents to a current healthcareprovider occurs only for documents in said ordered set which are notmarked private by said patient.
 7. The method of claim 1 wherein saidcategorization system is the same for all healthcare providers of saidplurality of healthcare providers.
 8. The method of claim 1 wherein saidcategorization system comprises a plurality of categories, saidcategories comprising a document identifier.
 9. The method of claim 8wherein said categories further comprise: an author of a page, aspecialization of said author, a date said page was created, a pagetype, a record source, or a name of a file provider.
 10. The method ofclaim 1 wherein said plurality of documents comprises scannedpaper-based pages of said patient's medical records.
 11. A method for apatient accessing said patient's medical records originating from aplurality of healthcare providers, wherein at least two healthcareproviders of said plurality have different medical records systems, saidmethod comprising: collecting from said plurality of healthcareproviders a plurality of documents of said patient's medical records,wherein said plurality of healthcare providers comprise a past and apresent health care provider of said patient; categorizing saidplurality of documents according to a categorization system, having morethan two categories; storing in a storage area of a central computerstorage said categorized plurality of documents, wherein said storagearea is under control of said patient; and retrieving a document of saidstored categorized plurality of documents according to at least one of aplurality of selection criteria, said plurality of selection criteriabased on said categorization system.
 12. The method of claim 11 furthercomprising displaying said retrieved document to said patient.
 13. Themethod of claim 11 further comprising displaying said retrieved documentto a third party after approval by said patient or said patient's legalsurrogate.
 14. The method of claim 11 further comprising displaying saidretrieved document to said patient, but not to said patient's legalsurrogate.
 15. The method of claim 11 further comprising distributingsaid retrieved document by fax, email, or hard copy.
 16. The method ofclaim 15 wherein said hard copy comprises a floppy disk, CD, microfiche,or paper copy.
 17. The method of claim 11 wherein said one selectioncriterion selects documents of said stored categorized plurality ofdocuments with document dates within the previous N months starting withsaid patient's most recent date of activity or a minimum of M documents,whichever results in more documents.
 18. The method of claim 17 whereinN=12 and M=3.
 19. The method of claim 11 wherein said categorizationsystem is the same for all healthcare providers of said plurality ofhealthcare providers.
 20. The method of claim 11 further comprisingdisplaying a document log of said categorized plurality of documents tosaid patient.
 21. The method of claim 20 wherein said document log isorganized by document date, page type, or doctor specialty.
 22. Themethod of claim 11 wherein said selection criteria selects documents ina category selected from a group of categories consisting of:Medications & Allergies, Immunizations, Patient Intake Apps, PhysicalExams, Progress Notes, Consultations, Operative Notes, ER Reports,Hospital Summaries, EKGs, Imaging Reports, Special Tests, Labs &Cultures, Therapy Notes, Billing & Insurance, and Other.
 23. The methodof claim 11 wherein said selection criteria selects documents in acategory selected from a group of categories consisting of: Medications& Allergies, Immunizations, Physical Exams, Progress Notes,Consultations, Operative Notes, ER Reports, Hospital Summaries, EKGs,Imaging Reports, Special Tests, Labs & Cultures, Therapy Notes, andPatient Added Pages.
 24. The method of claim 11 wherein saidcategorization system comprises a plurality of categories, saidplurality of categories comprising: document ID, page type, author ofsaid document, specialization of said author, provider of the record,and date of said document.
 25. The method of claim 24 wherein saidselection criteria selects documents in a category of said plurality ofcategories.
 26. The method of claim 11 further comprising, when needed,converting to electronic format each document of said patient's medicalrecords.
 27. The method of claim 11 further comprising, providing tosaid patient a Combined Medical Records (CMR) report, said CMR reportcomprising said categorized documents organized by sections, saidsections comprising a clinical pages section.
 28. The method of claim 27wherein said clinical pages section comprises Medications & Allergies,Immunizations, Patient Intake Apps, Physical Exams, Progress Notes,Consultations, Operative Notes, ER Reports, Hospital Summaries, EKGs,Imaging Reports, Special Tests, Labs & Cultures, Therapy Notes, Billing& Insurance, and Other sub-sections.
 29. The method of claim 11 furthercomprising, providing to said patient a Medical Summary (MS) report,said MS report comprising said categorized documents organized bysections, said sections comprising a selected clinical pages section.30. The method of claim 29 wherein said selected clinical pages sectioncomprises Medications & Allergies, Immunizations, Physical Exams,Progress Notes, Consultations, Operative Notes, ER Reports, HospitalSummaries, EKGs, Imaging Reports, Special Tests, Labs & Cultures,Therapy Notes, and Patient Added Pages sub-sections.
 31. The method ofclaim 11 further comprising, searching for a doctor's location using acustomized search engine.
 32. A method for a patient accessing saidpatient's medical records originating from a plurality of healthcareproviders, said method comprising: collecting from said plurality ofhealthcare providers said patient's medical records; categorizing aplurality of documents of said patient's medical records according to acategorization system; storing in a storage area of a central computerstorage said categorized plurality of documents, said storage area undercontrol of said patient; and displaying a document log of saidcategorized plurality of documents to said patient.
 33. The method ofclaim 32 further comprising displaying a time line graph indicating adate when a document of said categorized plurality of documents wascreated.
 34. The method of claim 32 wherein said document log comprisesan inventory of said categorized plurality of documents sorted bydocument ID, page type, author of said document, specialization of saidauthor, record provider, or document date.
 35. The method of claim 32wherein said document log is sorted by date in reverse chronologicalorder.
 36. The method of claim 32 wherein said document log comprises alink to a display of a document of said categorized plurality ofdocuments.
 37. A system for centrally managing a plurality of medicalrecords of a patient distributed across a plurality of healthcareproviders, said system comprising: a collection module for collectingfrom said plurality of healthcare providers said plurality of medicalrecords, a computerized categorization system for categorizing eachmedical record of said plurality of medical records, wherein saidcategorization system is the same for all healthcare providers of saidplurality of healthcare providers; a patient directed central storagearea for electronically storing said categorized plurality of medicalrecords; and a retrieval module for retrieving an ordered plurality ofdocuments of said categorized plurality of medical records, wherein saidordered plurality of documents is arranged using at least one of aplurality of criteria, said plurality of criteria based on saidcomputerized categorization system.
 38. The method of claim 37 furthercomprising a display for displaying said ordered plurality of documents.39. The method of claim 38 wherein said display for presenting comprisesa Web browser.
 40. The method of claim 37 further comprising adistribution module for creating a CD, email, facsimile document, orprinted document comprising information in said ordered plurality ofdocuments.
 41. The method of claim 37 further comprising a search engineapplication stored in a computer readable medium for locating a doctoror an organization of said plurality of healthcare providers.
 42. Themethod of claim 37 wherein said categorization system comprises:document ID, page type, author of said document, specialization of saidauthor, provider of the record, and date of said document.
 43. A methodof centrally managing medical records of a patient authored by aplurality of healthcare providers, said method comprising: collectingfrom said plurality of healthcare providers a plurality of medicalrecords, wherein said plurality of medical records comprise a pluralityof paper based documents, and wherein said plurality of healthcareproviders comprise a past and a current health care provider;classifying each page of said plurality of paper based documents usingclasses of a classification system common across said plurality ofhealthcare providers; converting each page of said plurality of paperbased documents to an electronic image; storing each electronic image ina computer readable medium wherein access to said computer readablemedium is authorized by said patient; retrieving an organized subset ofsaid electronic images, using at least one of a plurality of criteria;and displaying an electronic image of said organized subset.
 44. Themethod of claim 43 wherein said classifying each page comprises adding aheader and a footer to each page, wherein said header comprises a firstgroup of classes of said classification system and said footer comprisesa second group of classes of said classification system.
 45. The methodof claim 44 wherein said first group comprises: a document ID, pagetype, patient name, and member ID.
 46. The method of claim 45 whereinsaid page type is a medical category selected from a group consistingof: Medications & Allergies, Immunizations, Patient Intake Apps,Physical Exams, Progress Notes, Consultations, Operative Notes, ERReports, Hospital Summaries, EKGs, Imaging Reports, Special Tests, Labs& Cultures, Therapy Notes, Billing & Insurance, and Other.
 47. Themethod of claim 44 wherein said second group comprises: author of saidpage, author's specialization, if a doctor, and creation date of saidpage.
 48. The method of claim 43 wherein said classification systemcomprises: a document ID, page type, patient name, member ID, author ofsaid page, author's specialization, if a doctor, and creation date ofsaid page.
 49. A system for centrally managing a plurality of medicalrecords of a patient originating from a plurality of healthcareproviders, said system comprising: a backend server for receiving saidplurality of medical records from said plurality of healthcareproviders, wherein each document of said plurality of medical records iscategorized; a database connected to said backend server for storingsaid categorized documents, wherein access to said categorized documentsis controlled by said patient; and a Web server connected to saidbackend server and to a client system, wherein said Web server processesa search request by said client system for retrieving a set of ordereddocuments of said categorized documents, said set arranged by using atleast one of a plurality of criteria.
 50. The system of claim 49 furthercomprising a scanner coupled to said backend server for converting apaper-based document of said plurality of medical records to anelectronic image for storing in said database.
 51. The system of claim49 further comprising a search engine for locating a healthcare providerof said plurality of healthcare providers.
 52. The system of claim 49further comprising a window displaying a current collection status of apatient's medical records from a healthcare provider of said pluralityof healthcare providers.
 53. A method in a computer system fordisplaying a document log of a plurality of medical records of apatient, comprising: displaying a table comprising a plurality of rows,wherein each row comprises a plurality of columns, wherein a column ofsaid plurality of columns comprises a plurality of cells associated witha category of a plurality of categories; and displaying document ID datain a cell of said plurality of cells of a row of said plurality of rows,wherein said document ID data identifies a document in said plurality ofmedical records.
 54. The method of claim 53 wherein said plurality ofcategories comprises: document ID, page type, author of said document,specialization of said author, provider of the record, and date of saiddocument.
 55. The method of claim 53 wherein said document ID datacomprises a hyperlink to an electronic image of said document, andwherein, when said hyperlink is selected, said electronic image isdisplayed.
 56. A method, using a computer, for enabling a patient tocomment on a medical record of said patient, comprising: searching foran electronic image of said medical record using a category assigned tosaid medical record, said electronic image stored in a database, whereinaccess to said electronic image is controlled by said patient; receivinga patient's comments; and electronically linking said patient's commentswith said electronic image.
 57. The method of claim 56 furthercomprising displaying said patient's comments concurrently with saidelectronic image.
 58. The method of claim 56 further comprising storingin said database said patient's comments, and retrieving said patient'scomments, when said electronic image is displayed.
 59. The method ofclaim 56 wherein said category is selected from a group consisting ofdocument ID, page type, patient name, member ID, author of saiddocument, specialization of said author, provider of the record, andcreation date of said document.
 60. The method of claim 56 furthercomprising: receiving a doctor's comments; and electronically linkingsaid doctor's comments with said electronic image.
 61. A method in acomputer system for displaying to a patient a document timeline of aplurality of documents in a patient's medical records, comprising:displaying a first axis having sequential calendar time units;displaying a second axis listing said plurality of documents; andproviding an indication along said first axis of a creation date of atleast one of said plurality of documents.
 62. The method of claim 61wherein said indication on said first axis includes a name of an authorof said document and said date of creation.
 63. The method of claim 61wherein said listing of said plurality of documents is by medicalsub-categories.
 64. The method of claim 61 wherein a document of saidplurality of documents comprises a document identifier, said documentidentifier comprising a hyperlink to an electronic image of saiddocument, and wherein, when said hyperlink is selected, said electronicimage is displayed.
 65. The method of claim 61 wherein said calendartime unit is selected from a group consisting of day, month, and year.66. A method in a computer system for displaying a progress notetimeline of a plurality of progress notes in a patient's medicalrecords, comprising: displaying a first axis indicating sequentialcalendar time units; displaying a second axis indicating a total numberof said plurality of progress notes for each sequential calendar timeunit; and providing an indication along said first axis of said totalnumber of said plurality of progress notes with creation dates in acalendar time unit of said sequential calendar time units.
 67. Themethod of claim 66 wherein said calendar time unit is selected from agroup consisting of day, month, and year.
 68. A method for using apatient's medical records by a doctor, comprising clinical pages, storedin a patient directed computer storage area, said method comprising:said doctor selecting a category of a plurality of categoriescategorizing said clinical pages; retrieving from said computer storagearea a subset of clinical pages, wherein said subset comprises aplurality of clinical pages belonging to said category and notdesignated private by said patient; calculating an availability factor,wherein said availability factor is a ratio of a number of clinicalpages belonging to said subset to a total number of clinical pagesbelonging to said category; and displaying said availability factor tosaid doctor for use in evaluating completeness of said subset.
 69. Themethod of claim 68 wherein said plurality of categories comprise aplurality of medical sub-categories of a page type category.
 70. Amethod for using a patient's medical records by a doctor, comprisingclinical pages from a healthcare provider, stored in a patient directedcomputer storage area, said method comprising: said doctor selecting acategory of a plurality of categories categorizing said clinical pages;retrieving from said computer storage area a subset of clinical pagesbelonging to said category; calculating a source factor, wherein saidsource factor is a ratio of a number of clinical pages in said subsetobtained directly from said healthcare provider to a total number ofclinical pages in said subset; and displaying said source factor to saiddoctor for use in evaluating reliability of said subset.
 71. The methodof claim 70 wherein said plurality of categories comprise a plurality ofmedical sub-categories of a page type category.
 72. The method of claim70 wherein said total number of clinical pages in said subset is a sumof clinical pages in said subset obtained directly from said healthcareprovider plus clinical pages in said subset obtained via said patient.